OMS Anesthesia Team Model in Trouble?
In 2016, California Governor Jerry Brown (D) signed legislation (AB 2235), known as “Caleb’s Law.”
The legislation stems from the 2015 death of six-year-old Caleb Sears at an OMS office during a general anesthesia procedure. The bill was championed by the boy’s family and in particular his aunt, Dr. Annie Kaplan. Dr. Kaplan led the charge and was very active in the press and on social media on this issue.
Her goal: to prohibit operator-administered anesthesia in dental offices.
Her goal: to prohibit operator-administered anesthesia in dental offices. There were heated hearings, passionate testimony by friends and family of the specialty, and attacks on the OMS anesthesia team practice by the Dental Anesthesiologists among other provider groups.
Dental Board Investigates
Through extensive lobbying and negotiation on the part of the California Association of OMS, no formal policy changes were included in the final bill signed by the governor and the bill only required the Dental Board of California to establish a committee to investigate whether the current laws, regulations, and policies of the state are sufficient to guard against unnecessary use of anesthesia for young patients and potential injury or death.
CA Board Recommends Changes
The state’s Dental Board established the committee mentioned in the legislation prior to the bill’s final enactment. In December, the Dental Board submitted final recommendations for the legislature to consider during the 2017-2018 legislative session. The Dental Board chose to recommend requiring a separate anesthesia provider be utilized for children under the age of seven undergoing sedation.
The Dental Board chose to recommend requiring a separate anesthesia provider … for children under the age of seven.
This decision was made after heated testimony during their hearings on this issue, including testimony from the California chapters of the ASA and American Academy of Pediatrics, and despite recognizing they did not have firm data to support such action. The legislature must approve the recommendations for them to become law. This would be done through a bill and the normal legislative process. To date, this bill has not been introduced and we are awaiting introduction.
Texas Probes OMS Team Model
The Texas State Board of Dental Examiners (TSBDE) is currently undergoing review by the Texas Sunset Commission, wherein the legislature will continue the authorization of the TSBDE, but may also make any legislative amendments it feels are necessary.
Throughout 2016 the commission held hearings into various aspects of the TSBDE. The Texas Society of OMS has been highly involved throughout the process, providing both written and verbal comments during the proceedings.
Blue Ribbon Panel Investigates Incidents
Given several high profile incidents within the state related to dental anesthesia in the past year, anesthesia took a prominent role in the Commission’s investigation. Heated testimony also occurred during the Commission’s hearings, including several dental anesthesiologists challenging the OMS anesthesia team model and citing the California bill/incident, but they did not reach the same level of intensity as Caleb’s law testimony.
Anesthesia took a prominent role in the Commission’s investigation.
Rather than the Commission dictating changes to the state’s dental anesthesia statutes and regulations, the Commission charged the TSBDE to establish a Blue Ribbon Panel (BRP) to review de-identified patient data on the adverse events to determine what, if any, changes need to be made to state law. The BRP released its findings earlier this month.
Texas Panel Exonerates O-A
The Commission reviewed this report and accompanying recommendations on Jan. 11. Commission members generally concluded, and the BRP members agreed, that the data showed that lack of individual provider vigilance and competence was the root cause of the adverse events they reviewed and that emergency protocols and the standard of care were not followed. The Commission members also concluded that utilizing an “OMS anesthesia team model” did not have an impact on the adverse events that occurred within the state.
“…OMS anesthesia team model” did not have an impact on the adverse events…
The Commission is now drafting a legislative package based on its review of the TSBDE and other agencies up for review this year. The package will include several recommendations the commission adopted in Aug. 2016 and Commission members indicated that they would work to incorporate the BRP’s recommendations into the final version.
Once the bill is introduced, it will go through the same committee process as any other bill introduced in the legislature and it may be amended throughout the process. To date, this bill has not been introduced and we are awaiting introduction.